How Much Has Changed?

As a horse owner who reads about research studies and ways to treat equine conditions on a daily basis, I periodically recall my own horsey emergencies, thinking, "If we had only known then what we do now." With today's technologies maybe my veterinarian could have saved the gelding with wobbler syndrome we euthanized years ago. Or perhaps my old show jumper with that lingering ligament injury would have benefited from some form of regenerative medicine.

But while listening to John Walmsley, MA, VetMB, Cert. EO, Dipl. ECVS, HonFRCVS, founder of the U.K.'s Liphook Equine Hospital, recall the technological advances he's observed over his 40 years in practice during the British Equine Veterinary Association's 51st annual Congress, I realized something: No matter how advanced equine medicine becomes, nothing can replace the value of a basic veterinary exam or a practitioner's skill.

With new technologies comes the challenge of learning to interpret them correctly.

Photo: Anne M. Eberhardt

In his hourlong plenary lecture Walmsley rattled off a list of veterinary conveniences we take for granted today, reminding the audience that 40 years ago equine hospitals only existed at universities, health records were paper, and there were no such things as disposable syringes or gloves, mobile phones, or the Internet. Vets didn't have at their fingertips the diagnostic imaging options, fiber-optic techniques, or even sedation methods they do today.

He used ultrasound's advent in the 1970s as an example: "It gave us diagnostic abilities that have transformed the management of breeding mares." Now it's important for a variety of uses, from scanning tendons and measuring soft tissue lesions to evaluating the cardiovascular system and guiding joint injections.

Advances in fiber optics used in diagnostic modalities such as video and flexible endoscopy, laparoscopy, and arthroscopy have contributed to earlier recognition of problems and development of new treatment methods. "How rewarding it is to show the client a lesion in those once mysterious spaces such as the upper airway, bladder, or stomach," Walmsley said. "In 2012 there is hardly an equine cavity that has not been examined endoscopically."

Radiography has evolved from dark rooms and drying racks to detailed digital as well as computed images. Scintigraphy (bone scanning) is now common practice and helps practitioners diagnose fractures and bone involvement in soft tissue injuries. Field anesthesia has become far more sophisticated with the introduction of detomidine sedation and has expanded the scope of surgeries that can be performed on the farm. And both high- and low-field magnetic resonance imaging have given veterinarians the ability to evaluate bone, tendon, and tissue pathology in one exam.

Walmsley also noted that although most developments he's seen relate to technology, the introduction of scientific journals has been crucial in growing veterinarians' body of knowledge and their commitment to excellence. "Alongside this we have developed a more critical attitude to our clinical work," he explained.

But rapid veterinary advances, however positive, can present problems such as unnecessary use of expensive imaging, overinterpretation and misinterpretation of images, unrealistic client expectations, and a lack of necessary ¬training/skills as practitioners race to install the latest and greatest machines without fully understanding them, Walmsley cautioned.

"Our responsibility as veterinarians is to use this technology in the best interest of the horse," he said. "But ultimately, nothing replaces the clinical examination."

Regardless of the vast collection of new discoveries and technologies available, a veterinarian's time-tested knowledge and experience are still what determine arrival at the best diagnosis and treatment outcome. As one of Walmsley's colleagues told him, "Never do a test unless the result might change what you do."

Ultimately, would some miraculous (not to mention pricey) surgery or stem cell treatment have saved the lives or careers of my horses past? Perhaps. But after listening to Walmsley's lecture I realized maybe veterinary medicine hasn't changed all that much: We still trust and rely on these highly qualified horse doctors to assess our animals and do what's in their best interest.

"The clinical examination is still the backbone of clinical practice," Walmsley said in conclusion. "But we hope that the lot of the horse has been improved by the diagnostic and surgical repertoire new technologies have given us."

Alexandra Beckstett is the associate managing editor of The Horse: Your Guide To Equine Health Care. She and her two Warmblood mares reside in Lexington, Ky.

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